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Registration #:OC HEALTH CARE AGENCY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTHExpiration Date:APPLICATION FOR BACKFLOW PREVENTION ASSEMBLY TESTER REGISTRATION NAMED ATE LastFirstMiddleHOME ADDRESS Number

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How to fill out backflow tester registration form

01

Obtain the backflow tester registration form from the appropriate local or state agency.

02

Fill in your personal information such as name, address, and contact details.

03

Provide details of your backflow tester certification including the certificate number and expiration date.

04

Include information about your testing equipment and methods used.

05

Sign and date the form to certify that all information provided is correct.

06

Submit the completed form along with any required fees to the relevant agency.

Who needs backflow tester registration form?

01

Backflow testers who are required by law to register with the local or state agency.

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What is backflow tester registration form?

Backflow tester registration form is a document that must be completed by individuals who test backflow prevention devices.

Who is required to file backflow tester registration form?

Backflow testers are required to file the registration form.

How to fill out backflow tester registration form?

The form can typically be filled out online or in person by providing personal information, certification details, and any relevant experience.

What is the purpose of backflow tester registration form?

The purpose of the form is to ensure that only qualified individuals are testing backflow prevention devices to protect the public water supply.

What information must be reported on backflow tester registration form?

Information such as personal details, certification number, testing experience, and contact information must be reported on the form.

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